Wednesday, June 9, 2010

ROA Meets with Deputy Director for TMA

ROA met with Rear Admiral Christine Hunter, Deputy Director for the TRICARE Management Activity (TMA), June 8. Three important topics were discussed.

Gray Area Access to TRICARE

While a quarterly meeting, ROA did ask for a briefing on TRICARE Retired Reserve (TRR) as part of the agenda. RADM Hunter reassured ROA and the other associations in attendance that implementation still looks good for an October 1 start time. ROA reminded the admiral that there is a need for an enrollment period prior to commencement of this benefit, and mentioned that the TRICARE contractors have concerns that they haven't been given a go ahead and are nearing their milestone for an October 1 start date. RADM Hunter said she would contact the contractors and follow-up on this. Per the law, Gray Area retirees can buy into the TRR program, paying a premium equal to the full cost.

TRICARE "25"

Also discussed was the implementation for access of TRICARE for dependents through age 25. Included as part of the National Defense Authorization bill, DoD health affairs cannot fully implement this program until it is signed into law. While the House has passed a provision, the Senate version could differ, affecting how things are implemented. TMA is moving ahead in advance of legislation to have much of the process in place, so that they can move ahead promptly.

The Department of Health and Human Services (HHS) has released an interim final rule about the expansion of health care to dependents under age 26 for commercial plans. The rule is 67 pages long. While DoD is not affected by this rule, TMA is studying it to determine if the TRICARE plan could include elements of the National Reform program.

Of note, the cost to include a dependent under the National Plan would be $3300 a year. Under the HHS rule, companies do not have to charge a separate premium, but this doesn't mean the benefit is free. It is expected that the cost of dependents on commercial plans will be spread across all health care beneficiaries, raising every plan's cost. One area of discussion is how a "dependent" will be defined. Under the HHS program, even if a child is married, a parent can include them as a dependent for health care plans.

TRICARE doesn't have as wide a base and up to a 1/4 of a million dependents could become eligible. Under the House language a separate premium would be charged. Using TRICARE Reserve Select as a bench mark, the anticipated cost as calculated by the Congressional Budget Office would be $2000 per year. One thing being resolved is how an above-threshold dependent will be identified in the system. While TRICARE may be extended, these young adults will not retain any of the other "dependent" benefits. It is likely that a TRICARE health card will be issued, in lieu of military ID.

Medicare/TRICARE 21 percent Doc Fee on Hold

Congress has yet to change the law, with a 21 percent cut to physician fees paid by Medicare and TRICARE still unresolved. Before the Memorial Day recess the House did pass a version which would prohibit these cuts for 19 months (until December 2011), but no action was taken in the Senate. The Senate is expected to pass legislation this week, but agreement between the two chambers is needed before it can become law. Medicare payments to doctors are on hold for the third time this year. TRICARE continues to pay, because adjustments within their system have a longer lead-time, and Congress normally delays the cuts before action by DoD is necessary.

First, I share Col Carter's sentiments. Many thanks to Marshall Hanson & ROA staff. Second, I assume "full cost" means just that and no more. For example, premiums for Tricare Reserve Select are at 28% of full cost, which in FY10 are $49.62/mo member-only and $197.65/mo member & family. Doing the math, that's about $177 and $706 respectively, more than I now pay for a high deductible/co-pay plan (Aetna). Another factor as I look at TRR is the provider network. I live in an area (MN) where a large majority of hospital systems and physicians are not participating providers, not even the University of MN or county hospitals, nor the coveted Mayo Clinic which earlier this year began a pilot program at its Arizona clinic to help determine whether to drop Medicare patients at all its clinics. Not the best situation, especially for families of deployed soldiers. By comparison, all the health insurance plans in MN have a comprehensive network of providers. Although Tricare is a good benefit, an effort needs to be made to beef-up the provider network, so that it is truly worthy of the sacrifices of service members and families it is designed to serve.

TRS is for drilling Reservists in pay. Because they are subject to recall, their premiums are subsidized by DoD. Upon retirement, an option of TRR provides continuity of health care. TRS and TRR both use the TRICARE Standard, mechanism, which mean that the benefits are similar. TRR will be without a subsidy, while no formal rates are yet published, a family premium rate should be around $700 a month.

Once you transition from the Selected Reserve to the Retired Reserve, you are no longer eligible for TRS. Having said that, ROA advocated this year to have the Department of Defense Health Affairs folks implement a Cobra plan for the Selected Reserve on TRS so you can buy into the Continuing Health Care Benefit Program. Look into that as an option. Info can be found at www.Tricare.mil

I read the article about Rear Adm. Hunter in the "Military Officer" magazine. I work for a pharmacy that compounds sublingual immunotherapy (SLIT/allergy drops). We are owned by a retired Navy officer who served as a physician. I am wondering what needs to be done to get SLIT looked at again through TRICARE. Prescribing allergy drops to both active duty/retired military patients would save the government money. SLIT is safer than allergy shots to treat the underlying cause of allergies. Allergy drops are able to match several of TRICARE's four responsibilities because it is safe, convenient, and can be beneficial in managing health care costs.